Rural Georgia’s Champions for Maternal Heart Disease Awareness

 Author:  Lauren Nunally, MPH, BSN, RNC-OB

WomenHeart

WomenHeart is a national coalition founded in 1999 by three women who had suffered heart attacks in their 40s and found they had shared experiences such as delay in final diagnosis, feeling isolated, uninformed and depressed until meeting while being interviewed for a magazine article on women and heart attacks.

Sandy Wells RN and Alicia Roberts, who unfortunately has recently passed away, have been the coordinators of WomenHeart Hinesville.  Sandy will continue in her role as Co-founder of the organization. The impressive development of this team of dynamic and determined women began when Alicia was diagnosed with cardiomyopathy and congestive heart failure soon after delivery of her daughter when she was just 26 years old. Alicia attended cardiac rehab for therapy, facilitated by her nurse, Sandy. For additional support with adjusting to the life changing medical condition, Alicia joined WomenHeart Savannah. Inspired by the program and developing a more positive outlook to her prognosis, Alicia decided to undergo training provided by the national organization and became an educator for WomenHeart.

WomenHeart Hinesville

The Hinesville chapter of WomenHeart, was founded in February, 2018. Their goal is to increase awareness and provide support to women who are at risk, currently have or have had heart disease. This is achieved through monthly support groups, through health services provide by WomenHeart at Work, regular walk schedules and other special events. WomenHeart Hinesville has partnered with Liberty Regional Medical Center (LRMC) to enhance its community outreach efforts and to serve as a referral source for local cardiac care and rehabilitation.

Liberty Regional is 1 of only 2 Critical Access Hospitals that still deliver babies. Through their own Perinatal Quality Collaborative Program, they have been participating with the GaPQC and reporting data since April 2018.  The data reported contains measures related to Process, Structure and Outcome.  Process Measures include provider education and protocol, risk assessment and quantified blood loss.  Structure Measures include patient, family and staff support, debriefs, multidisciplinary case review, hemorrhage cart, unit policy and procedure, and EHR integration.  The Outcome Measures reflect the goal of the program which is to decrease the overall rate of Maternal Mortality and Morbidity.

Dr. Seth Borquaye, OB/GYN, of Liberty Obstetrics and Gynecology, and Dr. Akinniran Abisogun, Cardiologist with SouthCoast Health, are consulting physician partners of the support group.  Other partners include Resurrection Ink, Liberty County Chamber, Liberty County Minority Chamber, Liberty County School System, Liberty Regional Medical Center and the City of Hinesville.

 

 

Management of Cardiac Disease in Pregnancy and Postpartum

Every pregnant woman at LRMC that has chronic HTN, gestational HTN, or preeclampsia is referred for a complete cardiac workup.  This information is used as a baseline for any future issues. Before being discharged home, the OB nurses make sure all postpartum mothers that have risk factors are provided with detailed discharge instructions that include a signs and symptoms flyer, infographic educational sheet, CVD risk factor educational sheet and how to recognize symptoms that warrant immediately contacting a healthcare provider or return to the hospital.   Patients who are at risk for heart disease or those that may already have signs of heart disease are also referred to Dr. Abisogun for a cardiology follow up, with most women being seen within 3 weeks of delivery.

The WomenHeart Banquet was held during national heart health week to educate the community about the pressing issue of heart disease. The Hinesville team came up with ways to involve the community by having a WomenHeart Health Infographic Challenge for the students as part of the Healthcare Pathways at Liberty College and Careers Academy. The 1st, 2nd and 3rd place winners were recognized at the February meeting of the Hinesville City Council.  A PSA video was also developed for educating the community, where local survivors shared their experiences and humanized the issue of perinatal cardiac disease. This video and the infographic sheet are being used to educate postpartum mothers at LRMC.

Why We Fight Campaign: The health of the community has always been the primary drive for WomenHeart Hinesville and leading the charge to lower the maternal mortality rate in the state of Georgia is important for the community now and in the future. The “Why We Fight” Campaign brought together patients, the medical community, educators, businesses and community leaders to make a change. The primary focus is reeducating the public and even health care providers to consider heart disease as a potential cause for complications during pregnancy and postpartum. WomenHeart Hinesville’s goal is to educate and inspire.

A major challenge the Hinesville team faces with the community they serve is behavior or lifestyle changes.  While they acknowledge people need continued support and coaching, funding for these activities is difficult to come by.

Future goals: The WomenHeart Hinesville purposes to:

  • Work with LRMC to educate medical staff about the risk of cardiovascular disease in women who have complications during pregnancy. This includes prioritizing education, training and access to medical resources for healthcare providers.
  • Educate on the importance of lifestyle modification when risk factors are present.
  • Perform research to determine the impact of lifestyle modification on heart disease in women who have complications during and/or after pregnancy.
  • Community outreach to provide awareness of the risks and ways to prevent progression of the disease.
  • Call upon city governments, education systems and businesses to partner with the medical community to educate the community about lifestyle modifications.

The remarkable work this multidisciplinary team performs in the corner of the state is no doubt a model of best practice that appears to be easily replicable in other locales.  The impact of their outreach interventions may seem to be the tip of the iceberg; nevertheless, they continue with gusto and tenacity to raise awareness of cardiovascular disease in women, targeting not just those at risk, but all members of the community who have a loved one who could benefit from the knowledge gained.

Overview of Peripartum Cardiomyopathy:

Peripartum cardiomyopathy (PPCM) is defined as heart failure that may develop toward the end of pregnancy or in the months following delivery, where no other cause of heart failure is identified.   The etiology remains ambiguous but symptoms can be mild or severe. Though prognosis has improved substantially over the past several years, women with peripartum cardiomyopathy are still at risk for adverse outcomes.

Preeclampsia and eclampsia are associated with PPCM and may have shared pathophysiology.

Stats in U.S. and GA

Peripartum cardiomyopathy occurs in 25–100 per 100,000 live births in the United States.  According to the ACOG Practice Bulletin, #212; Pregnancy and Heart Disease, in the U.S., cardiovascular disease is currently the primary cause of death in pregnant women and women in the postpartum period, (4.23 deaths per 100,000 live births), equating to 26.5% of pregnancy-related deaths.  MMR data from 2012-2015 revealed Cardiomyopathy accounted for over 25% of pregnancy related deaths. (DPH 2020)

Most women (50-80%) will make a full recovery with a normal or near-normal ejection fraction within the first 6 months after developing PPCM. These women have significantly lower mortality rates and better chances of improved cardiac function.

Of the women who continue to have reduced cardiac function, subsequent pregnancies are associated with a 25% mortality rate and ongoing decline in cardiac function. However, with increased recognition and understanding of heart failure management and improved treatment, PPCM mortality rates have decreased to as low as approximately 3% within 6 months postpartum.

Management: ACOG recommends patients with moderate and high-risk cardiovascular disease should be managed during pregnancy, delivery, and the postpartum period in medical centers with, at a minimum, a multidisciplinary team that includes obstetric providers, maternal–fetal medicine subspecialists, cardiologists, and an anesthesiologist.

 

 

 

 

DEDICATION – This article is dedicated to the memory of Alicia Roberts 10/6/1983 – 2/23/2020.

 

 

 

 

 

 

 

 

 

References:

ACOG (2019). Practice Bulletin, #212; Pregnancy and Heart Disease. OBSTETRICS & GYNECOLOGY (133) 5, pp. e320-e356

Georgia Department of Public Health. (2020), Maternal Mortality Fact Sheet 2012-2015.  Retrieved from https://dph.georgia.gov/document/document/mm-factsheet/download

WomenHeart https://www.womenheart.org/